INVESTIGATIVE SERVICES FORM

Today's Date: May 21, 2012
IP Address Logged: 38.107.179.213

All non-corporate clients must submit an Investigative Agreement

For Worker's Compensation Investigations, a PDF Form may be submitted in lieu of the E-Form.

You will receive an email confirmation once you successfully complete this E-Form. A confirmation page will also appear, which you should print for your records.

If this form cannot be used because of the nature of the case, please contact us at (773) 353-0074 and press 718.

Type:
Surveillance	GPS Track	Background Investigation
Locate	Process Service	Computer Forensics
Other:

Subject Information:
Last Name:     First Name:
Middle Name:
Date of Birth:	Home Phone:	Cell:
Gender: Male Female	Race:      Height:      Weight:
Social Security Number: (i.e. xxx-xx-xxxx)
Eyeglasses: Yes No Occasionally      Hair Length:      Hair Color: None Black Blond Blue Brown Gray Red      Eye Color: Blue Brown Green Hazel Gray
Distinguishing Physical Traits:
Address:	City:      State:      Zip:
Occupation:	Marital Status: Divorced Married Single Unknown Domestic Partnership
Job Location:	Location Details:
Spouse/Partner'sName:
Dependants’ Name and Ages:
Behavioral Patterns (always stops at the same place for coffee, restaurants/bars/gyms frequented, habits, hobbies, friends, etc...):
Description of subject vehicles:
Have previous investigations been conducted? Yes No
If Yes, list dates/agencies:
Referral Date: ...	Client needs report by: ...
Photo Upload:
Special instructions and/or comments:

Requester Information:
Last Name:     First Name:
Phone: Fax:
Company Name:
Address (No PO Boxes):		Unit/Apt./FloorSuite:
City:      State:      Zip:
E-Mail:
How would you like to receive the report? EMail/Online Overnight 2nd Day Priority Mail

Toll Free: (866) 696-9443
E-Mail: info@theatlantisgroup.us

Licensed and Fully Insured. Illinois Licenses 117001393, 122001060